Possible to have success in more larger cities?

[KnuxNole]

The fear that I have is wanting to move to bigger cities upon finishing residency, but worried that options are scarce. I've been told that FM doctors are being recruited left and right, and that it shouldnt be too hard to find adequate jobs. One of the places that I don't see myself is in small towns, and in conservative locations. Suburbs, that connect to cities that isn't too far(<30) or even actually living in a decent size urban city are places where I would see myself living and practicing

However, it seems like in larger areas, there is a lot of specialties around, and the demand for FM docs is lower, which might make it difficult. As far as what I've seen in terms of those AAFP journal classified, it seems they mainly advertise in smaller towns. I feel as if I don't want to get my hopes up, only to find it would be a massive struggle.

I was wondering for people who practice in a larger city, if it would be actually possible to do so as a newly graduating FM resident. I still have some time to go, but I am curious....seeing as before I know it, I'll have to find a job :O

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Members don't see this ad.

 

[Mad Jack]

http://www.indeed.com/q-family-practice-physician-$110,000-l-ny,-ny-jobs.html
http://www.indeed.com/q-family-practice-physician-$100,000-l-san-francisco,-ca-jobs.html
http://www.indeed.com/q-family-practice-physician-$120,000-l-los-angeles,-ca-jobs.html
http://www.indeed.com/jobs?q=family+practice+physician+$150,000&l=washington,+DC
http://www.indeed.com/q-family-practice-physician-$130,000-l-philadelphia,-pa-jobs.html
http://www.indeed.com/q-family-practice-physician-$110,000-l-austin,-tx-jobs.html

There's like a thousand big city jobs I managed to find in less than three minutes. I'd say that if you want to work in a city, you're good lol.

 

[smq123]

The fear that I have is wanting to move to bigger cities upon finishing residency, but worried that options are scarce. I've been told that FM doctors are being recruited left and right, and that it shouldnt be too hard to find adequate jobs. One of the places that I don't see myself is in small towns, and in conservative locations. Suburbs, that connect to cities that isn't too far(<30) or even actually living in a decent size urban city are places where I would see myself living and practicing

However, it seems like in larger areas, there is a lot of specialties around, and the demand for FM docs is lower, which might make it difficult. As far as what I've seen in terms of those AAFP journal classified, it seems they mainly advertise in smaller towns. I feel as if I don't want to get my hopes up, only to find it would be a massive struggle.

I was wondering for people who practice in a larger city, if it would be actually possible to do so as a newly graduating FM resident. I still have some time to go, but I am curious....seeing as before I know it, I'll have to find a job :O

There is still quite a bit of demand for FM, even in larger cities.

Rural, somewhat isolated jobs kind of HAVE to advertise in the AFP journal. Other jobs in larger cities frequently fill by word of mouth, and don't need to hire a recruiter or advertise as heavily.

 

[styphon]

In larger cities, if you want to work with the middle class AND above - you most likely will be limited to Adult non-pregnant patients, basically acting as an IM outpt doctor. There are lots of positions for these - but the scope of practice is limited because of the extreme amount of specialists/subspecialists present in large cities, and often the groups contract with said specialists. The exception is academic family medicine clinics - you may be allowed to practice full spectrum FM with what every population you serve.

Practicing in the poorer aspects of the city - can be full spectrum FM and will have trouble getting specialist consults outside of Academic employed doctors, will also work for lower pay than the above.

Its all about what you want, and what will make you happy.

 

[Silent Cool]

http://www.indeed.com/q-family-practice-physician-$110,000-l-ny,-ny-jobs.html
http://www.indeed.com/q-family-practice-physician-$100,000-l-san-francisco,-ca-jobs.html
http://www.indeed.com/q-family-practice-physician-$120,000-l-los-angeles,-ca-jobs.html
http://www.indeed.com/jobs?q=family practice physician $150,000&l=washington, DC
http://www.indeed.com/q-family-practice-physician-$130,000-l-philadelphia,-pa-jobs.html
http://www.indeed.com/q-family-practice-physician-$110,000-l-austin,-tx-jobs.html

There's like a thousand big city jobs I managed to find in less than three minutes. I'd say that if you want to work in a city, you're good lol.

Wow. As if the pathetically low salaries above (well for a physician, anyway) weren't reason enough to avoid FM/IM like the plague, look at this little gem:

http://parallon-force-com.careerliaison.com/Perm/ts2__JobDetails?jobId=a1kC0000000C5yXIAS&amp;tSource=&_CL_SOURCE=20833356&jtsrc=www.jobcastle.com&jtsrcid=16238&jtrfr=http://www.indeed.com/q-family-practice-physician-$120,000-l-los-angeles,-ca-jobs.html&utm_source=Indeed&utm_medium=cpc&utm_campaign=Indeed

"Specialty:Family Practice Contract #:LT 08488Location:Los Angeles, California Salary:Competitive...

....

Other Acceptable Specialties: Family Nurse Practitioner"



My mother was saying that, in recent years, the physician demographic at the medical clinic our family has used for years has changed such that practically all the primary care doctors are from foreign countries. Now I know why!

Yes, the joy of taking care of patients as a doctor can be yours for only 500K....or you could have the hospital pay you to become an NP and make the same bank. LOL

 

[deleted87716]

So...you find a desperate ad looking for somebody (anybody!) to do locums work in a low-income area of L.A., combine that with an unrelated anecdote (N=1) and then attempt to extrapolate that to the entire U.S. primary care physician market...?

Fail.

 

[Mad Jack]

Wow. As if the pathetically low salaries above (well for a physician, anyway) weren't reason enough to avoid FM/IM like the plague, look at this little gem:

http://parallon-force-com.careerliaison.com/Perm/ts2__JobDetails?jobId=a1kC0000000C5yXIAS&amp;tSource=&_CL_SOURCE=20833356&jtsrc=www.jobcastle.com&jtsrcid=16238&jtrfr=http://www.indeed.com/q-family-practice-physician-$120,000-l-los-angeles,-ca-jobs.html&utm_source=Indeed&utm_medium=cpc&utm_campaign=Indeed

"Specialty:Family Practice Contract #:LT 08488Location:Los Angeles, California Salary:Competitive...

....

Other Acceptable Specialties: Family Nurse Practitioner"



My mother was saying that, in recent years, the physician demographic at the medical clinic our family has used for years has changed such that practically all the primary care doctors are from foreign countries. Now I know why!

Yes, the joy of taking care of patients as a doctor can be yours for only 500K....or you could have the hospital pay you to become an NP and make the same bank. LOL

There's decent paying PCP jobs out there, they're just in the middle of nowhere. It's a sad thing, the state of primary care nowadays. 180k isn't terrible pay in most cities, but I wouldn't say it is worth the debt.

 

[Silent Cool]

There's decent paying PCP jobs out there, they're just in the middle of nowhere. It's a sad thing, the state of primary care nowadays. 180k isn't terrible pay in most cities, but I wouldn't say it is worth the debt.

@madjack ,

Would you say the avg. pay for IM, Peds, Psych is equal to, higher than, or lower than the above?

 

[Mad Jack]

@madjack ,

Would you say the avg. pay for IM, Peds, Psych is equal to, higher than, or lower than the above?

http://www.medscape.com/features/slideshow/compensation/2014/public/overview#2

Higher.

 

[VA Hopeful Dr]

There's decent paying PCP jobs out there, they're just in the middle of nowhere. It's a sad thing, the state of primary care nowadays. 180k isn't terrible pay in most cities, but I wouldn't say it is worth the debt.

180k is usually starting. Most docs I know make significantly more once they get a full schedule.

Let's do some quick math. Let's assume 25 patients/day, each generating 1 RVU (even though most will generate significantly more). 5 day work weeks. You work 47 weeks out of the year. Let's also say you're earning the national average of $39/RVU. That works out to a yearly gross of 230k.

Now, if we actually make these numbers more realistic: Assume 1.5RVU per patient but only 20 patients in a day. 4.5 day work week, work 47 weeks again. Same RVU rate. Now we're looking at 247k.

Heck, Josh at AtlasMD has regularly said that he and his partners gross about 240k and I would be shocked if Blue Dog isn't at least there but I suspect higher.

 

[Silent Cool]

So...you find a desperate ad looking for somebody (anybody!) to do locums work in a low-income area of L.A., combine that with an unrelated anecdote (N=1) and then attempt to extrapolate that to the entire U.S. primary care physician market...?

Fail.

That is just one example. There are many others just like that. You seem to be one of the few people who insists that primary care is just swell, when the experiences of many others indicate the opposite.

Fail.

 

[VA Hopeful Dr]

That is just one example. There are many others just like that. You seem to be one of the few people who insists that primary care is just swell, when the experiences of many others indicate the opposite.

Fail.

Disagree. There are lots of us who still enjoy what we do. I regularly e-mail with my residency class, and the only one who isn't happy is working as a prison doc.

Here's the short version - there can be decent money in FP. Will it be the same as ortho, of course not - but we work fewer hours, have less call, and have a shorter residency. It can be a very satisfying job if you do it right - Josh seems to love his job, BD likes his, even CB enjoys the work (which her type of work sounds awful to me, but to each his own). I'm having a good time currently.

There are unhappy doctors in every specialty, don't kid yourself.

Oh, and please continue to tell us how much being a family doctor sucks. I do so value a pre-med's opinion on the subject.

 

[Mad Jack]

180k is usually starting. Most docs I know make significantly more once they get a full schedule.

Let's do some quick math. Let's assume 25 patients/day, each generating 1 RVU (even though most will generate significantly more). 5 day work weeks. You work 47 weeks out of the year. Let's also say you're earning the national average of $39/RVU. That works out to a yearly gross of 230k.

Now, if we actually make these numbers more realistic: Assume 1.5RVU per patient but only 20 patients in a day. 4.5 day work week, work 47 weeks again. Same RVU rate. Now we're looking at 247k.

Heck, Josh at AtlasMD has regularly said that he and his partners gross about 240k and I would be shocked if Blue Dog isn't at least there but I suspect higher.

That's gross income though. Practices have expenses- billing, insurance, desk staff, maybe a nurse or two, facilities, utilities, supplies, etc. Many of these already hefty expenses are exacerbated in a city. In a large group, you could get a reasonable chunk of that 247k, but in a smaller group or in a for-profit hospital that wants to skim some cash off of you, you'll probably be seeing a lot less.

Atlas works on a different practice model than most, so he's kind of an outlier. Is it possible to clear the 200k bar after expenses? Certainly. But usually you're looking at doing that by either utilizing PAs and NPs to enhance physician productivity or by offering ancillary services. Cities just make pulling it off very hard, because there's a lot of competition on the ancillary side of things and PAs and NPs tend to demand higher wages than in the sticks.

 

[KnuxNole]

In larger cities, if you want to work with the middle class AND above - you most likely will be limited to Adult non-pregnant patients, basically acting as an IM outpt doctor. There are lots of positions for these - but the scope of practice is limited because of the extreme amount of specialists/subspecialists present in large cities, and often the groups contract with said specialists. The exception is academic family medicine clinics - you may be allowed to practice full spectrum FM with what every population you serve.

Practicing in the poorer aspects of the city - can be full spectrum FM and will have trouble getting specialist consults outside of Academic employed doctors, will also work for lower pay than the above.

Its all about what you want, and what will make you happy.

True, the last bit is key! I don't foresee myself doing OB in practice, and doing adults/kids in outpatient would be nice. In terms of happiness, I ideally want to live near or in a liberal big city. Nowhere conservatives or small. It is a balance though. I'd rather made relatively less money in a location where I can be truly happy vs. making more money in a place I'd be miserable and depressed at for life.

 

[Postictal Raiden]

That's gross income though. Practices have expenses- billing, insurance, desk staff, maybe a nurse or two, facilities, utilities, supplies, etc. Many of these already hefty expenses are exacerbated in a city. In a large group, you could get a reasonable chunk of that 247k, but in a smaller group or in a for-profit hospital that wants to skim some cash off of you, you'll probably be seeing a lot less.

Atlas works on a different practice model than most, so he's kind of an outlier. Is it possible to clear the 200k bar after expenses? Certainly. But usually you're looking at doing that by either utilizing PAs and NPs to enhance physician productivity or by offering ancillary services. Cities just make pulling it off very hard, because there's a lot of competition on the ancillary side of things and PAs and NPs tend to demand higher wages than in the sticks.

I believe in the calculation above, VA Hopeful Dr used workRVU value, not totalRVU, which is usually twice as much as wRVU. Therefore, assuming 50% overhead costs, running the numbers using wRVU values should give you a rough estimate of your take home income.

 

[Mad Jack]

Ah, makes much more sense. That seems reasonable then.

 

[VA Hopeful Dr]

I believe in the calculation above, VA Hopeful Dr used workRVU value, not totalRVU, which is usually twice as much as wRVU. Therefore, assuming 50% overhead costs, running the numbers using wRVU values should give you a rough estimate of your take home income.

Exactly. I'm using work RVUs because that's how most hospital systems determine how much you make.

 

[Dharma]

I know we've been through this before, but there's nothing starting at anywhere close to 180k in our large metro area. That's a pretty typical salary for several years in practice in a busy practice, though the girlfriend still isn't up to that after 3 years full-time with 3 weeks a year of vacation.

OUCH! Man every time I start fancying the idea of FM (with thoughts of moving back closer to a big city) a thread like this comes along. That said, I know there are good number of folks in suburbs of these locations starting up and above 170K.

 

[cabinbuilder]

Disagree. There are lots of us who still enjoy what we do. I regularly e-mail with my residency class, and the only one who isn't happy is working as a prison doc.

Here's the short version - there can be decent money in FP. Will it be the same as ortho, of course not - but we work fewer hours, have less call, and have a shorter residency. It can be a very satisfying job if you do it right - Josh seems to love his job, BD likes his, even CB enjoys the work (which her type of work sounds awful to me, but to each his own). I'm having a good time currently.

There are unhappy doctors in every specialty, don't kid yourself.

Oh, and please continue to tell us how much being a family doctor sucks. I do so value a pre-med's opinion on the subject.

Yes, I am very happy in locum land, no one owns me, I make my own schedule, I'm off when I want to be, can make as little or as much as I want (I will be very close to 300K this year). Actually just got job in urgent care right by my house so at least this next year I will be home for a while. Will see how long that lasts.

 

[BestDoctorEver]

Yes, I am very happy in locum land, no one owns me, I make my own schedule, I'm off when I want to be, can make as little or as much as I want (I will be very close to 300K this year). Actually just got job in urgent care right by my house so at least this next year I will be home for a while. Will see how long that lasts.

Do you purchase your own health insurance? How do you save for retirement?

 

[cabinbuilder]

Do you purchase your own health insurance? Yes
How do you save for retirement? Pennies in the pickle jar

 

[BestDoctorEver]

Do you purchase your own health insurance? Yes
How do you save for retirement? Pennies in the pickle jar

Lol...I use my mattress...

 

[cabinbuilder]

Lol...I use my mattress...

I knew you would understand.